Thursday, July 11, 2013

Home Health Series I: Home Care or Assisted Living?

Home care or assisted living?  You may currently be facing this decision with an elderly loved one and the answer is certainly not an easy one.  Seniors who were once independent and self sufficient may now suffer from a myriad of health concerns and getting assistance is not only a matter of economics, it is also a very emotional decision.  Trustiva Health has developed the table below for an at-a-glance comparison of both types of care delivery.


In-Home Care
Assisted Living
-       Privacy and comfort
-       Complete independence in scheduling & routine
-       Reassurance of your own surroundings
-       One monthly cost (may or may not cover ADLs)
-       Facilities designed for safety and mobility of seniors
-       Socialization and recreation
-       Potentially higher cost
-       Intrusive on family members
-       Additional cost for ADL assistance
-       Emotional distress of being away from home
-       Little control over schedule and routine
Room and Board Expenses including Utilities and Food
Not included
$39,600 Annually*
Assistance with ADLs
$61,152 annually* (8-hours per day of Certified Nurse’s Aide, 7 days per week)
May or may not be included.  Varies by facility type.
Not covered
Limited to some medically necessary health-related services by certified providers.
Some services may be covered by certified providers; services covered vary by state. Other housing/service costs are generally not covered.
Some services may be covered by certified providers where services covered vary by state. Adult day services may be covered; varies by state and eligibility.
Long Term Care Insurance
May be accepted; coverage varies by policy
May be accepted; coverage varies by policy
Veteran's Benefits
May be accepted; varies by eligibility and state
May be accepted; varies by eligibility and state

* 2013 figures from
It is a difficult decision to make but once decided upon, it will give the whole family peace of mind.  Call Trustiva Health today at 248-220-4052 to see how we can help.


Wednesday, May 8, 2013

Caregiver Series VII: How to Pay for Long Term Home Health Care

The aging process and the complications that come along with it, emotionally and physically, can be incredibly challenging for any family.  When mom or dad needs additional help through home care services, the associated costs can be intimidating.  Daily home health care at Trustiva Health is very affordable.  The company has no minimums and offers flexibility in scheduling with rates ranging from $10-$19/hour.  In addition to private pay, the list below details other ways to pay for long term care.

1.       Private pay

2.       Private Insurance:

a.       Long Term Care Policy

b.      Life Insurance Policy

                                                               i.      Death Benefit Loans

                                                             ii.      Accelerated Death Benefits

                                                            iii.      Life Settlements

                                                           iv.      Viatical Settlements

3.       Financing:

a.       Reverse Mortgage

b.      Home Equity Line of Credit

c.       Line of Credit (tied to other assets)

d.      Unsecured Senior Care Bridge Loan

4.       Medicaid

a.       MI Choice Waiver Program

b.      MI Home Help Program

5.      Non-Medicaid

a.       MI Adult Medical Program

6.      Federal Government

a.       Social Security (also known as Old Age, Survivors, and Disability Insurance)

b.      Veterans Aid and Attendance Benefit

Call us today at 248-220-4052 or visit

Monday, April 15, 2013

Caregiver Series VI: Sandwich Generation. What is right for your aging parents.

In the poem, Stop all the clocks, cut off the telephone, poet W.H. Auden anguishes about the loss of a love one: “My North, my South, my East and West; My working week and my Sunday rest”. Sometimes this loss occurs before death, as a familiar loved person fades in their ability to function as they used to.  Auden’s expression of pain about how his loved one could be swept away can serve as a reflection of the feelings of an adult child when their aging parent---their compass in many times past—begins to fail and is no longer capable of independently managing home and activities of daily living.

The loss of a parent’s independence often sets off deep feelings of sadness, betrayal, foreboding or even relief.  But no matter the range of feelings, the dynamic between parent and adult child changes. The child must assert and make decisions for the parent that are often difficult for everyone. Roles are often reversed. Dr. Nancy Giles, a therapist in Boston sees a parallel at opposite ends of the age spectrum: “It is rather the reverse of the independence dynamics with a toddler or even a teen. In that context the struggle can be to gain and define self. This adult child/aging parent scenario is about the surrender of one’s self." 

The Mayo Clinic suggests seven questions to help evaluate parental ability to maintain independent function:

- Are your aging parents taking care of themselves, such as their physical appearance?
- Are your aging parents experiencing memory loss?
- Are your parents safe in their home?
- Are your aging parents safe on the road?
- Have your aging parents lost weight?
- Are your aging parents in good spirits?
- Are your aging parents able to get around?

For some people the decisions of how to help an aging parent may be clear and agreeable. For others a parent may be independent in some ways, but no longer in others.  Resistance and defensiveness may be at high levels.

There are many resources to assist in making the decisions of what modifications of environment may be best for your mother or father. A good starting place for guidance may be a trusted and familiar physician. On line resources are abundant to help sort through questions to ask in choosing a home health service or live-in facility. Many resources are available to help you consider the financial decisions.  Here is a sampling:

In our next blog, we will investigate a variety of the resources available to make helpful changes, such as simple, but critical modifications to a parent’s home.  If you make the decision that the best solution is to remain in the home, we will explore effective ways to bring care to them.

If you have suggestions on this topic, please enter the conversation and let us hear your ideas and experiences. 

Wednesday, April 3, 2013

Caregiver Series V: Managing chronic illness with your diet.

Have you ever imagined a time when people no longer have to take drugs like Insulin, or daily doses of Lipitor to manage diabetes, high blood pressure and heart disease?  Would you believe that day is already here?  

Dr. M. Emin Donat, a Detroit-area gastroenterologist, says “it is possible for someone to reverse a diagnosis of type-2 diabetes, high blood pressure, even heart disease.” Donat sees success in his busy metro-Detroit practice, but he adds that success “often takes a year, and happens if people are willing to make a commitment and make tough choices.”   But for every one successful patient, “dozens more would rather take medicine, which is a patchwork approach, that doesn’t get at underlying problems.” 

These problems make heart disease the leading cause of death in the United States.  According to the American Dietetic Association, about 81 million Americans have some type of heart or cardiovascular disease.  That’s 35 percent of the population and doesn’t include the millions with diabetes.

Diabetes, high blood pressure, and heart disease are often related conditions and can be controlled making tough changes starting with losing weight.  

Controlling the fat and sugar content, plus eating smaller portions is the key combination for consistent and safe weight loss.  Switching to a vegetarian or vegan diet can also have a dramatic impact on weight loss and disease management goals.  Many people are put off by the thought of less or no more meat.  The following information comes from Colorado State University and explains types of vegetarian diets. 

Vegans, or total vegetarians, eat only plant foods; including fruits, vegetables, legumes (dried beans, peas, and lentils), grains, seeds and nuts.
Lacto vegetarians eat plant foods as well as dairy products, such as milk and cheese.
Lacto-ovo vegetarians eat plant foods, dairy products and eggs. Most vegetarians in the U.S. fit into this category.
Semi-vegetarians don’t eat red meat but may include chicken or seafood with plant foods, dairy products and eggs.
If you willing to try to reduce the amount of meat in your diet, it is a good idea to get some help. Check on-line resources with recipes, or buy a vegetarian cookbook.  Because if you make uninformed choices, you can hurt yourself.  “Vegetables are what you should be adding. Not eating less of something,” says Dawn Jackson Blatner, RD, LD, a spokesperson for the American Dietetic Association. “The same goes for carbs and eggs. Go overboard, and you can put yourself at risk for weight gain, heart disease, and out-of-control blood glucose. Replace carbs with beans and nuts. And limit yourself to two eggs a week; the rest of the time, get the same protein—minus the cholesterol—from egg substitutes, tofu, yogurt, or soy milk.”
Once you decide to make a diet change the resources with helpful recipes, and suggestions are almost unlimited.  The American Diabetes Association and the American Diabetic Association, as well as hospitals like the Mayo Clinic are good places to start.    And remember Dr. Donat’s suggestion that it can take up to a year to really notice the benefits of a radical change of diet.   But think how great you will feel when you realize you are actually more in control of your destiny than you thought.

American Diabetes Association
America Dietetic Association

If you have any success stories or suggestions to share with us, we would love to hear from you.

Friday, March 22, 2013

Caregiver Series IV: Stating your wishes in a medical emergency.

From the “news you can use” department…

The story last month about the death of an elderly California woman when an aide at her assisted living facility refused to give her CPR caught national attention.  After Lorraine Bayless collapsed, the aide called for an ambulance, but refused to further help Mrs. Bayless.   The 911 operator was outraged and the media questioned “what has our society become?” The deceased’s family has decided not to sue because inaction was in line with the elderly woman’s wishes.  This case should encourage all of us to ask ourselves questions.

What are your wishes for life saving care?  Do you know the wishes of your loved ones?  Does your state have a Good Samaritan law? What are the policies of any care givers you hire, or at the nursing facility where your loved ones may live? Are these consistent with your/your loved one’s wishes? Do you have a living will, and most importantly, do others know about it?

When trying to sort out all of this out, some commonly used terms worth knowing are advance directive, living will and durable power of attorney, and do not resuscitate order.

What is an advance directive?  This document tells your doctor what kind of care you would like should you be unable to make those decisions for yourself. Take note, the laws in Michigan differ from Ohio, or other states on advanced directives.

A living will is one kind of advanced directive.   A living will is a legal document that spells out what medical treatments you wish in a potentially life-ending situation.

A durable power of attorney document is also a kind of advanced directive.  The purpose of a durable power of attorney is to state another person you have selected to make decisions on your behalf when you no longer are able.

A do not resuscitate order also an advanced directive, prompts your doctor to put your directive in your medical chart detailing exact wishes.

Good Samaritan laws are in place to shield doctors, or others who help a person in an impromptu emergency situation from law suits.  Michigan has a Good Samaritan laws, which vary from most other state’s laws.

It turns out the Lorraine Bayless had apparently wished for no emergency life saving to be done in an emergency. But apparently and ironically her wishes were not known.   What seems to have surprised the emergency response 911 operator was the unwillingness of the staff at the assisted living facility to either help, or communicate why the aide wasn’t helping. 

Make sure that all of your nursing and home health resources are in line with your expectations. Some final questions to ask yourself; what level of care can you expect from a nursing facility? Is staff trained and permitted to perform emergency care? What emergency care do you want? Is the facility aware of your wishes?

All Trustiva Health caregivers are CPR trained with current certification and are trained to administer CPR (after calling 911) unless otherwise legally directed.
Here are some additional resources to help you in making medical planning decisions:

AARP Advance Directive Information
U.S. Living Wills Registry

If you have additional resources to share about medical planning we would love to hear from you. 

Friday, March 15, 2013

Caregiver Series III: Better Understanding Memory Loss.

There may be a breakthrough on the Alzheimer’s front, a disease impacting as many as 4.5 million Americans.
British scientists say they are closing in on a “cheap and easy screening” test to detect the earliest stages of the memory erasing disease. The scientists are hoping the test will be available in the next ten years. Until that time, we are left with more questions than answers.
What do you do if you, or a loved one begins down that slippery slope of forgetfulness?  How do you know if you are dealing with the signs of aging versus the symptoms of a disease whose results are loss of memory, thinking, and reasoning skills? 
According to almost all medical research the answer may be fairly simple: memory changes do take place due to aging, but when these memory problems interfere with daily life there may be a problem.  Severe memory loss is not simply the aging mind.
Alzheimer’s Disease was discovered in 1907 by Alois Alzheimer, but was not understood as a terminal disease until the 1970s.  And 40-plus years of research and treatment has taught us many things about common behaviors in the earlier days of the disease. They are:
·         Memory loss that disrupts daily life;
·         Challenges in planning solving problems;
·         Difficulty completing familiar tasks at home, or at work;
·         Confusion with the time and place;
·         Trouble reading, or judging distances;
·         Trouble following or joining a conversation with others;
·         Misplacing items and losing the ability to retrace steps;
·         Decreasing and poor judgment;
·         Removing oneself from social activities;
·         Poor hygiene; and/or
·         Changes in personality and mood, such as fear, depression, anxiety, and suspicion. 
If some or all of these symptoms are present in a family member or friend,  seeking medical confirmation is critical.  As diagnosis and treatment - as early as possible - can mean treatment that can lead to independence as long as possible.
The disease is quite difficult to manage and if independence is no longer a practical option, supervised care should be. Specially trained caregivers will keep an Alzheimer’s patient safe and content. Their care will focus on the realities of today and not the memories of yesterday.  The biggest problem for family members, says Dr. Jacob Mintzer, chairman of the Medical and Scientific Advisory Board for the Alzheimer's Foundation of America,  is often that "they're trying to preserve the person they knew as long as possible." It is indeed a terrible disease.
So much has been written about Alzheimer’s Disease and its progression, advice to patients and caregivers -- it is almost overwhelming.  However, here is a start: 

Alzheimer’s Association of America

Frequently asked questions about Alzheimer's disease from MedicineNet.
An overview of Alzheimer's disease from eMedicineHealth.
An excellent resource for caregivers is The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life.         
If you have additional resources to share about Alzheimer’s Disease, or care giving to someone with Alzheimer’s we would love to hear from you.  

Sunday, February 24, 2013

Caregiver Series II: Dealing with the stresses of being a caregiver.

The daily routine: Manage medication. Manage arrangements for doctor appointments. Manage the finances. Maintain a safe environment. Manage for adequate care when you’re away. Cook. Clean. Loads of laundry. Sound exhausting? It is.

You manage to get through your day and that of your loved one, but it is at a cost. “I feel smashed in the middle of being a mother and a caregiver,” said Christiana Alexander who lives in Nashville. Christiana says that she is often out of energy for her own family.  When she is caring for her mom, she often doesn’t feel the pleasure of her company.  The care of looking after her mother is compounded by the care needs of her mother’s second husband.  They live three hours away. 

Whether caring for your loved one downstairs, down the block or down state, primary caregivers can face the ongoing stress of sometimes performing critical and intricate tasks that once were done by experts or in a hospital. Dr. Steven H. Zarit, a Pennsylvania State University gerontologist states: “The tasks they shoulder have grown more demanding. Family caregivers now administer arsenals of medications and undertake procedures, from wound care to dialysis, that were once the province of medical professions.” Visiting nurses have noted that difficult tasks are left to older caretakers, who may have health issues of their own.

Supervising or giving the care can cause health problems for you. Pennsylvania’s Dr. Zarit and others list some common signs of caregiver stress:

Anger and resentment
Social isolation and loneliness
Anxiety and fear
Depression and dread
Irritability and short tempers
Sleep problems
Health complications 
Poor dietary habits

What can you do if you find yourself with any (or all!) of the signs of caregiver stress?

Psychologists emphasize healthy practices of “mindfulness”.  This is not just an art of focusing upon today.  It is a necessity when yesterday and tomorrow hold either too many unknowns, or the bleakness of stressful repetitions.  “Every day has a piece of relief tucked into it,” suggests Dr. Nancy Giles, a clinical psychologist in Boston.  “Your job is to see that lovely color or smell a comforting flower or listen to a beloved piece of music.”  Humor is essential. It actually promotes healing, inside and out.  Where do you find it in the sickroom or among hours of tending tasks?  Take ten minutes to try a book of short stories or cartoons. Exercise is a great help and can be fun to do with music.  Most of all, respect yourself.  Nothing can survive neglect.  If you do not take care of yourself, you cannot expect to have the strength and fortitude that is necessary to do the job for another.  When you have carved out the niche for yourself and your restoration, stop for one instant and reflect: “That one’s for me!”  Many communities have group meetings to share new ideas as well as the stresses.  

Here are some additional resources that you might find helpful:


Do you have ideas to help deal with the stress caregivers experience? We would love to hear from you! 

Friday, February 8, 2013

Caregiver Series I: Is it Seasonal Affective Disorder (SAD)?

When asked, most women are likely to know the answer to this question: “are you a summer or a winter?”  The inquiry typically refers to which colors are most flattering to you.  But, what does being a summer or winter person mean to you?  Surprisingly, the question has far greater reach than one’s self-perception; it also goes to your feelings and your energy levels during the different seasons of the year.  

If you are feeling down or irritable or a bit lazy on winter days, you are not alone.  Around 11 million Americans are feeling the same way as you. What we often call the “winter blues” has a clinical name, Seasonal Affective Disorder or SAD. The medical and mental health communities have defined medical symptoms associated with this mood disorder to describe these very personal feelings.

So, why may you feel blue in the winter? Your mood is influenced by hormones released while you sleep, and during your waking hours.  Those specific hormones are melatonin and serotonin.  Melatonin is the hormone that comes into play during sleep, and serotonin takes over while you are awake.  During the shorter daylight hours of winter months, our brain produces less serotonin, because it is responding to the darkness outside.   People who are sensitive to this shift feel it.  

The good news is that there are remedies the winter blues.  Here are some things you can try.
Light box/Phototherapy box.  Researchers say if a person is exposed to a light therapy box, which simulates bright outdoor light, for at least 30 minutes per day you may feel better.  They can be purchased on line through Walgreens, Amazon, or at Metro-Detroit Binson’s Home Health Care Centers. The cost of light boxes ranges from $39.00 on up, and are often covered by health insurance.
Dawn-simulating alarm clock.  This light therapy device works by increasing the illumination of your alarm clock in the time period before you awaken.  Dawn-simulating alarm clocks can be ordered on line with prices from $32.00 on up.
Exercise.  Walking outside has proven therapeutic effects. And it’s free! Walk with a friend or join a walking group to help inspire the discipline to keep walking.
Doctors in Finland believe your body can store up light in the summer to help combat the winter blues months later; important advice from a country that has long, dark winter days.  
Winter blues is not a new syndrome. In the second century, the philosopher Aretaeus wrote, “Lethargies are to be lain in the light, and exposed to rays of the sun.”
Do you have ideas to help ease the symptoms of SAD? We would love to hear from you!